][السنة Pathophysiology summary 2nd exam lectureDone by :abeer dirawi & ahmed alshamary & oday noaman & hadeel sumrain samsung ][اكتب اسم الشركة ][اختر التارٌخ
First lecture Summary Right and left side of the heart are separated from each other by fibrous tissue . There are two opening in the heart in the fetal life and should be closed after birth : 1-foramin ovali. 2-ductus arteriosus. For your informationductus arteriosus ,what is it??In the developing fetus, the ductus arteriosus (DA), is a blood vesselconnecting the pulmonary artery to the aortic arch. Upon closure at birth, it.becomes the ligamentum arteriosum The impulse transmit in the heart by the conductive system not direct between the atrium &ventricle ,except in rare situation called muscular bridge. The location of the heart: in the mediastinum between the 2nd -5th intercostal space. PMI= point of maximum impulse "where you can feel the impulse". Cardiomegaly :enlargement of the heart "the PMI will increase ". Papillary muscle: its the muscle attached to the atrioventricular valves via the chordae tendinae. Arteriole: control blood pressure. Vein: blood reservoir . The heart is self-excited . The heart work not under the direct control of the Brian ,but its affected by the sympathetic and parasympathetic system. Atrium innervated mainly by parasympathetic system & ventricle mainly by sympathetic system. The heart is affected by hormones mainly adrenaline and noradrenaline which is secreted by adrenal gland, they cause central vasodilation and peripheral vasoconstriction.
Alpha 1 :blood vessel Alpha 2 : heart vasodilatationvasoconstrictionBeta 1 : increase heart rate & Beta 2 : bronchi dilatationcontractility The vein affected by the sympathetic system more than any other blood vessels because they are blood reservoir . Done by: Hadeel sumrain.
Hypertension lec. summary Hypertension : It is sustained blood pressure beyond the normal average . - The normal blood pressure : - systolic : 120-139 mm - diastolic : 80-89 mm - BP = diastolic + 1/3(systolic – diastolic )Regulation of blood pressure : A. Short term regulation : moment to moment regulation controlled by barrow receptors . B. Long term regulation: the mechanism to maintain blood volume “there is compensated blood loss” !Signs & symptoms of hypertension : “ silent killer “ usually no symptoms but rarely it shows : - Headache - Blurry vision - Chest pain - Frequent urination at nightBlood pressure measurement : - Optimal : systolic < 120 & diastolic < 80 - normal : systolic < 130 & diastolic < 85 - high normal : systolic < 130-139 & diastolic < 85 – 89Causes of hyper tension : 1. Primary hyper tension: which is 90 -95 % of the cases that the cause of it is unknown. 2. Secondary hypertension , it’s only 5-10% that the cause might be cardiac , renal or endocrine ( these systems involved in the maintenance of blood pressure )
We can classify the factors which cause hypertension into twocategories: a) Controllable factors : increased salt intake , obesity , alcohol , stress, lack of exercise and smoking . b) Uncontrollable factors : heredity , race and age ( men 35-50 , women after menopause ).Hypertension may lead to Ischemic heart disease Myocardial infraction Stroke Congestive heart failure Kidney failure Heart attack Heart rhythm problems Aneurysm (localized, blood-filled balloon-like bulge . in the wall of a blood vessel).Medications : 1. Diuretics – get rid of excess fluids 2. Beta blockers –reduce HR 3. Calcium antagonist – reduce HR & relax BV 4. Angiotensin II receptors blockers 5. Vasodilators - malignant hypertension if it’s not treated it will be fatal - resistant doesn’t respond to treatment of three medications Done by: Abeer dirawi.
Heart Failure lec. summary Definitions occur together Heart Failure Pulmonary Edema The inability of the heart to maintain an An abnormal output adequate to accumulation of maintain the metabolic fluid in the lungs. demands of the body.Causes of Heart Failure1-Ischemic Heart Disease2-Cardiomyopathy3-Hypertension Valvular Heart Disease Congenital Heart Disease Alcohol and Drugs. Arrhythmias Ventricular Dilatation. Myocyte Hypertrophy.Salt and Water Retention. Sympathetic Stimulation. Peripheral Vasoconstriction.
When we need more Blood due to the body demand but at that time we were suffering from HF and low Cardiac Output then the Heart will do the Following 1-Sympathetic stimulation ( lead to #2) 2-Increase in heart rate , contractility ,cardiac output . 3-Release/formation of Angiotensin II to increase of the volume. 4-Vasoconstriction (Increase in the after load ) 5-Increase in the heart size (cardiomegaly )How can we discover that we have HFSigns: Cardiomegaly Elevated Jugular Venous Pressure Tachycardia Hypotension Bi-basal crackles – in the lungs Pleural effusion Ankle Edema Ascites Tender hepatomegaly Classification of heart failure " Symptoms of HF occur at rest and are exacerbated by any physical activity." Category Symptoms No limitation. heavy exercise Mild limitation normal physical activity Marked limitation gentle physical activity
Kussmaul’s sign Seen in Note that !1-constrictive pericarditis an increase in jugular2-right heart failure venous pressure and it is3-right ventricular infarction a sign of Right side heart4-tricuspid stenosis failure .5-restrictive cardiomyopathy6-"VIP" tamponade + degree of constricive pericardiditis Kussmaul’s sign Not Seen in 1- acute cardiac tamponade What is PMI and Where ? is the furthermost point outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt. PMI is at left 5th intercostals space, at the point of intersection with the left midclavicular line. PMI Abnormalities! 1- Dextrocardia, the apex beat may be felt on the right side. 2-Cardiomegaly , enlargement of the heart (at the 6th or 7th intercostals space). Heart Sound Name Time S1 Close of AV valve S2 Close of Semilunar valve S3 "Pathological after 40" Start of Diastole S4 "always Pathological " After Aerial Contraction
To do Compensatory mechanism Neurohormonal Increased HR Dilation Redistribution of -Sympathetic -Frank Starling Blood to the Brain-Norepinephrine - Contractility NOTE THAT! Vicious cycle will -Decrease in cardiac output -The body demand for more ALSO , Increase in the afterlaod TPR + Increase in the preload COP lead to more and more deteriorated of the heart ! ALSO , People who developed acute pulmonary edema , should have endotracheal, To get rid of excessive fluid
Treatment of HF ! 1. Diuretics . 2. Beta blockers . (Decrease CO) 3. ACE inhibitors (both preload and afterload will decrease .)Digoxin- increase the force of contraction by increase the Ca concentration inthe myocytes and decrease the HR.- Digoxin isn’t a safe drug the therapeutic index of it is narrow- Digoxin toxicity: High amount of the DrugLeads to 1. Dizziness. 2. Confusion 3. Discoloration, the patient will have yellowish discoloration 4. Loose of consciousness Note About Viagra Treatment: - general vasodilator -Digoxin immune fab - Cause Tachycardia -antidote for Digoxin - Fatal for Old people What is Cyanosis! It is the Blue discoloration of skin and mucus membranes, we can see it in the patient who has heart failure. We Cant treat the acute pulmonary edema by chest tube there is no air or fluid in the pleural cavity(cover the lung) excessive fluid usually are absorbed. Done By Prince Ahmed Al-Shamary
arrhythmia lec. SummaryArrhythmia :abnormality in the conductive system of the heart.The SA node is the pacemaker of the heart where the impulse should beinitiated ,but some time the impulse could be initiated elsewhere in the heartthis is called "ectopic beat ". Refractory period : the period of time come after each AP and the heartmuscle cant be excited through it because of the inactivation of fast Nachannel.Herat block : o 1-Block at the level of AV node : a- first degree heart block (PR > 0.22 sec.) b- second degree heart block(some P wave conduct ). C-third degree heart block(complete heart block). o 2- block below the AV node: a- block at bundle of his. b- block at the branches.Causes :acute MI, calcify aortic stenosis ,cardiomyopathy, drug,ischemia.Tachycardia : the HR more than 100/min (in ECG short PR interval)Bradycardia : the HR is less than 60/min( in ECG prolonged PR interval).The main cause of fibrillation are: o Strong electrical shock. o Sever ischemic heart disease.The main cause of AP re-entry : o Long pathway around the circle. o Decrees velocity of conduction . o Shortened refractory period of the muscle .Premature beat: o Premature atrial contraction:- the P wave occur too soon o Premature ventricular contraction:- the QRS complex prolonged .Ventricular tachy-arrhymia :Decrees in the COP , the ECG is odd shape.Anti-arrhythmic drug:B blockers & Ca or Na channels blockers & digoxin.Done by : Hadeel sumrain.
The kidney lec. summary Review of kidney structure and function Functions of the kidneys : excretion metabolic waste products ( Urea , Uric acid , Creatinine and Bilirubin ) e xcretion foreign chemicals ( Food additives , toxins , pesticides , drugs ) secretion , metabolism & excretion of hormones ( Renal erythropoietic factor, Renin and 1,25 dihydroxycholecalciferol ) Regulation of erythrocytes production Regulation of vitamin D activity (Vitamin D3 is important in calcium and phosphate metabolism ) Gluconeogenesis ( synthesis of Glucose ) Regulation of acid-base balance Regulation of arterial pressure ( Endocrine Organ and Control of Extracellular Fluid Volume. ) Regulation of water and electrolytes balances: And these functions are acomplished by a sereis of processes like Filtration , reabsorption , Secretion and Excertion of urineVery Important note :
Urine Formation by the Kidneys: Glomerular Filtration Renal Blood Flow, The functional unit of the kidney is the Nephron the reabsorption and the secretion happened between the pretubular capillaries and the tubules Filtration occurs between the glomerulus and Bowmans capsule Filtration: not selective (except for proteins), averages 20% of renal plasma flow Excretion = filtration – reabsorption + secretion Reabsorption: highly variable and selectiveWe have 3 layers glomerulus ( a network of capillaries ) :1-Epithelium of the glomerulus2-Basement membrane3-Endothelium Wall of bowmans capsule ( consists of non-dividingepithelial cells ( podocytes ) )Pathophysiology of the renal system1-Disorders of urine volume ( Anuria , Oliguria and polyria )2-Disorders in urine composition Hematuria ( blood od RBC’s in urine ) Proteinuria ( presence of abnormal concentration of proteins in urine )
Hematuria Proteinuria1-Glomerular bleeding suggests 1-Normally low molecularfracture in the GBM. weight proteins are filtered at the glomeruli.2-Glomerular bleeding maydevelop after strenuous exercise. 2-Normally albumin ( has a high M.W ) is not filtered at3-Recurrent episodes of gross glomerulihematuria associated with 3-Minor leakage of albuminrespiratory tract infection into glomerular filtrate mayindicates IgA nephropathy . occur temporarily after vigorous exercise fever and4-Glomerulonephritis with heart disease.deposition of IgA in mesangialcell. 4-Albuminuria is seen in early stages of glomerular disease of5-Red urine due to haematuria diabetes mellitus "diabeticmust be differentiated from other nephropathy " also incauses of red or black. hypertension.6-Red urine can sometimes be 5-Apperes in hypertention anddue to other reasons like food dye diapetus maletuas.or drugs.Done by: Oday noaman.
Kind of anemia Cause1-iron deficiency anemia. Due to deficiency of iron. Either by : a-loss of iron because of bleeding. b-inadequate iron intake. c-malabsorption. D- parasites.2-megaloblastic anemia. Due to deficiency of vit.B12 and /or folic acid. By: a-inadequate intake. b-IF deficiency(for vit.B12) c-diseases of terminal ileum(site of vit.B12 absorption) D-parasites. e-malabsorption (folate is mainly absorbed in jejunum) f- increase demand for folic acid.3-Aplastic anemia. Due to failure or reduction in the ability of the bone marrow to produce RBCs. the cause is either idiopathic, or because of :a- bone marrow inhibition by drugs. b- chemical effect. c-radiation. D- disease ex.viral hepatitis.4-Anaemia of chronic Associated with chronic diseases due to thediseases. inhibitory effects of cytokines on iron metabolism or erythropoiesis process.5-Haemolytic anemia. Due to excessive destruction of RBCs. either congenital :a-RBC membrane abnormalities . b- haemoglobinopathies. c-RBCs enzyme defect. OR..acquired: a- immune disease. b- non- immune :*mechanical causes . *infections. *drugs & chemicals. *malaria.6-Sickle cell anemia. Inheritance autosomal recessive trait.7-Anemia due to "G6PD" is important to generate "NADPH".deficiency of(G 6 P D).
.. ًمقارنة بٌن الصداع العادي ..والصداع النصف ..اوال ..فً سالٌد 7 هً تفسٌر بعض االشٌاءHas two of the following..ٌعنً عشان نحكً انه صداع نصفً الزم ٌكون عنا على االقل اثنٌن من هذه.. االعراض1-unilateral location...بٌكون بجهة واحدة اما بالٌمٌن او الٌسار2-pulsating quality... ًٌعنً االلم زي النبض بٌروح وبٌج3-severe intensity...الم حاد4-aggravated by activity..."بٌزٌد مع القٌام بالنشاطات "العملmigraine Tension headacheUnilateral bilateralPulstating quality constantSevere intensity Not severeAggravated by activity Do not Aggravate by activityAssociated with vomiting or Not Associated with vomitingphotophobia/phonophobia or photophobia/phonophobia. ٌنزعج من الضوءPhotophobia:ً ٌنزعج من الصوت العالPhonophobia:
Test your selfQ)the impulse in the heart conduct directly between the atrium and ventricle, Trueor false?A-false.Q)in normal person the PMI should be on which intercostal space?A- on the 5th intercostal space.Q) what will happen if one of the papillary muscles get ruptured ?A-the blood will back to the atrium and that will reduce the output of the heart.Q)The resting coronary blood flow equal ?A- 225 ml/minQ) The perfusion occurs during the systole , True or false ?A- False, during diastole .Q) if the metabolic regulation increase then the blood flow will………?A- increase.Q) sympathetic stimulation increase the heart rate and contractility and decrees thecardiac output , True or false ?A- false, "increase the cardiac output" .Q) when there is a complete occlusion of the coronary artery this will lead tonecrosis . necrosis is less severe than ischemia ,true or false ?A- 1- True . -2- false.Q) The location of the obstruction do not affect the quantity of myocardial ischemia,true or false ?A- false.Q) What do we mean by " ectopic beat" ?A- its an abnormal case when the impulse of the heart initiated not in the SA nodebut elsewhere .
Q)regarding Refractory period why the heart muscle cant be excited through it?A- because of the inactivation of fast Na channel.Thanx alooot for :Abeer dirawi & Ahmed Al shamary & Oday noaman ..the best of luck